急诊门奇断流术治疗门脉高压食管胃底静脉曲张破裂大出血的疗效分析

The analysis of the efficiency of emergent portal-azygous disconnection with splenectomy for portal hypertention with acute massive hemorrhage

目的总结和分析脾切除加门奇断流对门脉高压食管胃底静脉曲张破裂大出血的疗效。方法回顾性对比分析2002年1月至2006年3月间本院急诊门奇断流术29例和择期门奇断流术20例的资料,探讨急诊门奇断流术的疗效。结果本组49例术后上消化道出血均停止。急诊手术的手术并发症发生率、术后再出血率两组间无显著性差异,但急诊手术的死亡率为6.7%,明显高于择期手术的死亡率0%。结论急诊脾切除加门奇断流术治疗门静脉高压食管胃底静脉曲张破裂大出血是安全有效的治疗方法,止血效果确切,肝功能衰竭和肝性脑病发生率低。

Objective To summarize the curative effect of emergent portal-azygous disconnection with splenectomy for treating the hepatocirrhosis portal hypertention with acute massive hemorrhage due to esophageal varicose vein and varices of fundus of stomach.Methods A retrospective analysis was made on the results of 49 patients with hepatocirrhosis,portal hypertension who were treated with portal-azygous disconnection with splenectomy from Jan.2002-May.2006.29 cases were treated with emergency operation because of acute massive upper digestive tract hemorrhage.Results Upper digestive tract bleeding was controlled by portal-azygous disconnection with splenectomy in all patients.There were no significant difference between these two groups in the incidence of postoperative complications and rehemorrhage.But the mortality of the emergency group is 6.7%,much higher than that of the selective group.Conclusion Emergent portal-azygous disconnection with splenectomy for treating the hepatocirrhosis portal hypertention with acute massive hemorrhage is a safe and effective procedure in controlling bleeding with low incidence of liver failure,operation mortality and encephalopathy.